Provider Demographics
NPI:1871694851
Name:WORSHAM, PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:WORSHAM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 N CAUSEWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6435
Mailing Address - Country:US
Mailing Address - Phone:985-867-8100
Mailing Address - Fax:985-867-9222
Practice Address - Street 1:2629 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6435
Practice Address - Country:US
Practice Address - Phone:985-867-8100
Practice Address - Fax:985-867-9222
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1241111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAU85423Medicare UPIN
LA4C185Medicare ID - Type Unspecified
LA5CB28Medicare PIN